No GPs?

All graduates have to be trained on the job, they don't come out of uni with the skills and experience they need to be a fully trained employee. If they go into the public sector they are being trained at the public expense. The high cost of training doctors is a reflection of the high level of training they need to be a doctor and what makes them difficult and expensive to replace which is why they should be valued, paid properly and have good working conditions. It is a stupid waste of money to do anything other than that particularly as it is the junior doctors who take the greatest load in training those doctors who are junior to them. They actually do the training that you want them to pay for! See one, do one, teach one is how it works but you do need to be able to "see one" and every doctor who leaves is a lost trainer as well as a doctor.

That’s my point Casdon. Doctors who emigrate have already worked in the NHS for at least two years as F1 and F2. Then most go to work for longer in the NHS as my daughter did, in her case for fourteen years. No private company would put a payback term of 14 years into a contract. Private companies wouldn’t expect employees to contract themselves for more than two years, therefore since doctors already do two years, it’s a moot point. I don’t think doctors would want to not pay fees at university for a contract binding them to many years service in the NHS. It would be unreasonable and unwanted. And most do many years service in the NHS anyway.

Payback deals are always time limited though, aren’t they?

My son is just an example of how it is not discriminating against medical professionals to have a payback deal in place. They are not unusual.

Yes, he could have worked elsewhere - as it happens he is happy where he is and isn't looking to leave, but that's not the point.

foxie Absolutely. Why pick on doctors when other people who provide public services wouldn’t be included in such a scheme? As you rightly point out, teachers have a very high level of leaving the profession within a few years. There is a huge teacher shortage but people don’t notice it because they’re not affected by it. Class sizes are rising and teachers are teaching subjects that they are unqualified to teach, but no one notices. However they notice when they can’t get a GP appointment.

Doodledog your son could choose to work for any company, he didn’t have to accept the conditions, but doctors can’t choose to not work for the NHS. Consultants can work privately much, much later on, but all doctors have to work for the NHS. Their choice, when they’ve had enough, is to emigrate. Presumably your son didn’t need to do that in order to get a good deal.

I don't want to discriminate against anyone.

This thread is called 'No GPs', not 'No teachers, or civil servants'. When people complain that they can't see a GP they are told that this is because so many of them leave the country to get better pay and conditions abroad. This means that we are paying a lot of money to train (eg) Australia's doctors. We are also told how expensive it is for doctors themselves to go through the lengthy training, and the cost to the public is over £250,000.

A possible solution to that would be to pay the whole of the training costs for them, and to ask for the payback to be that they either stay in the UK for X years, or pay back the cost of their training, as is normal in many professions.

Teachers, social workers and civil servants don't get years of expensive training subsidised by the public. I think that some teaching courses have bursaries, but that is for one year during which they teach, and it is the same for social workers (I think - I'm not certain whether the bursaries apply nowadays). Civil servants go straight into work from university AFAIK, unless you mean spies and the like. Anyway, if we were discussing the dropout rate in those groups, a similar scheme may well be mooted, but we aren't.

Doodledog what I don't understand is why you want to discriminate against doctors. There are lots of professions that require training post graduation that is effectively supported by the public purse eg social work, teachers, civil servants etc but you only focus on the medical profession. A third of teacher leave the profession in the first five years, the proportion for social workers is even higher. There is still a cost to training them post qualification but this is never mentioned and I don't understand why.

Thanks for your support Annajay.
And I agree about asking Pharmacists for help. They are very useful at times.

maddyone

Doodledog

Why is it 'punitive' to pay for someone's training in return for their staying in the country that paid for it?

My daughter worked in the NHS for fourteen years after she qualified. Is that enough?
(She also worked in clinical practice for the last two years of her training. Whilst she was learning, she was also doing much of the routine work so that more qualified doctors didn’t need to do those more routine things.) So a total of sixteen years including those two on clinical practice. Is that enough?

I don't have a clue what's 'enough'. I am simply suggesting a different model - one where medical students don't pay for their training in return for whatever it costs to pay back the cost. Obviously they would still have to contribute to things like their own health, education for their children and so on, as we all do, so the 'payback' would be on top of that basic taxation, and probably wouldn't cover the full cost of training, or it would be a deterrent, but it seems like a good deal to me. No student debt, no need for parents to make sacrifices, and enough doctors trained each year to ensure that any who do leave are replaced.

It's not punitive, as people could still leave if they wanted to, but as with my son they would be expected to pay at least some of the cost of their training. They would be no worse off than if they had paid for it themselves (my son would have had to pay the whole cost of his postgrad qualifications plus a penalty clause). The details would be for people with far more knowledge and understanding of the NHS and how it works than I have - I don't pretend to know enough to come up with what is 'enough'. Maybe it wouldn't work, but I can't see the harm in discussing it.

That’s interesting foxie. My town is on the list. Now I know why we can’t get a gp appointment without jumping through many hoops, and I can’t jump these days. 🙁
My dd has worked nearly 25 years in the nhs so I know how difficult it is.

Doodledog

Why is it 'punitive' to pay for someone's training in return for their staying in the country that paid for it?

My daughter worked in the NHS for fourteen years after she qualified. Is that enough?
(She also worked in clinical practice for the last two years of her training. Whilst she was learning, she was also doing much of the routine work so that more qualified doctors didn’t need to do those more routine things.) So a total of sixteen years including those two on clinical practice. Is that enough?

foxie I completely agree with you, but I know that you know that already. The problem is underfunding. When the last Labour government was in power, the NHS improved considerably because they put so much more money into it. I know lack of money isn’t the only problem, but it is the main problem in my opinion. And holding down the salaries of doctors as this government has done is merely making more doctors leave. Improve salaries and conditions and fewer would leave. That is how you maintain a workforce, not by forcing them to stay, basically saying you owe us because we trained you.
I don’t know how a future Labour government would deal with this, but I worry that it will not do very much due to lack of funds. That worries me.

maddyone what really makes me angry is that people blame doctors for the mess that's the NHS is in. It's like blaming the fish in the sea for dying because of pollution. Doctors are as much victims as their patients, they are not responsible for the problems but whilst most of them keep swimming some decide to get out of the water! Young doctors do not want to be GPs, they all get a lot of exposure to primary care in their medical training and what they experience completely puts them off. I think the question is "why" not how can we force them to stay in practice. A huge amount of worthwhile primary care work can, quite properly, be handled by nurses and other specialists who are not doctors. However, some patients seem to feel they've been "short changed" if they don't see a doctor. I was seen by a young GP and told I'd got late onset asthma and was given steroids, I saw the practice asthma nurse, did a peek flow test, she said definitely not asthma and she was correct. I re-injured an achilles tendon, GP called in the physio to look at it saying "she's the expert". I think we need to stop blaming doctors for the under funding of the NHS and put that blame where it lies which is squarely at the door of our current govt and if we need to pay more into the NHS, then let's get on and do it.

Why is it 'punitive' to pay for someone's training in return for their staying in the country that paid for it?

henetha

I truly don't feel that I have a doctor at all now. My old GP retired six years ago and I was assigned to a new one and I have yet to set eyes on him. On the rare occasions that I have needed to see a doctor in the last few years it's always a different one. And now it is even more difficult to get an appointment at all. So I generally don't bother. I'd rather google things and then buy medications online. Obviously I would not do this if it was something serious, but for many everyday problems it is perfectly satisfactory.
I feel somewhat cynical about the whole GP thing.

I think it is a perfectly reasonable expectation that we all take care of our everyday, minor health problems in this way, perhaps seeking the advice of a pharmacist. As you say, you would contact your doctor for any problem which appeared to be more serious which you could not resolve for yourself, and that is exactly how the GP service should be used.

Oh dear what is happening to the world? I have not had any medical needs since 2019 (broken ankle) except once in February 2022 which took me weeks to set up online as it was impossible to choose the right option (they conveniently missed out 'one to one'' on the list) I finally got a phone appointment with a practice nurse after 2 weeks who made me the GP appointment that I knew I needed the following week. Today I have spent over an hour trying again online as all I want is another prescription for a cream I know works on my insect bites. Nothing of any kind available in the next 16 weeks. I found a telephone number and the polite lady got me a telephone pharmacist appointment in a week, out of hours. After I had explained the impossibility of making any appointments online she then said I might then have to make a GP appointment Aaargh!!!! She also told me my prescription for the skin cream years ago was listed as for migraines!! Oh isn't technology wonderful?!

Thanks for all your kind comments re my pancreatic cancer diagnosis. Sadly I didn’t have heartburn symptoms but rather an unusual back ache. I am sure a face to face appointment would have been helpful. But I am one of the lucky ones. 75% of people diagnosed with pancan are dead within a year. I’m still here after 19months. 🥳

Incidentally she worked for fourteen years in the NHS before she left for New Zealand. She doesn’t owe any of us a penny!

Oh my Lord foxie, my daughter would have loved that, a twenty k inducement. She received no inducement, nor her (now ex) husband.
I agree with you totally, we absolutely should not be even suggesting punitive measures in order to recruit GPs or doctors in general. What a horrible idea. We don’t own them. They pay for their university tuition exactly the same as other students, but many other students graduate after three years (not the six my daughter spent at university) and then go on into private industry, where they earn far more in a lifetime than most doctors. Sometimes they have to agree to stay for six months, or even a couple of years, but essentially they work and earn for themselves. If they want to take their skills abroad, they can do. Where this idea that we somehow own doctors because we paid for their education originates from, I don’t know, but we pay for every other student’s education too, and no one suggests they pay it back, beyond what they already pay.
We paid our daughter’s accommodation, books, food, and all other expenses whilst she was at university and it cost us about ten thousand a year because she was at university in London. Perhaps the NHS should pay me back!

I really don't think you improve retention with punitive measures, you do it by improving working conditions, pay and demonstrating that an employee is valued. fwiw nearly 800 newly qualified doctors failed to obtain a foundation year one training place in 2022. Some of them will have gone to work abroad as they wouldn't have the necessary registration to work as a doctor in the UK. What does that say about how we value the training they have received? However, this is a situation which will continue to worsen as we put more students through medical schools. Competition to obtain specialist training posts is fierce and often doctors are left marking time before they can progress their training so they opt to leave the country and tbh I don't blame them! No problem getting on GP training courses though if you are prepared to move to one of the areas where it's difficult to recruit GPs. They get a £20K hello and provided they stay 3 years they don't have to pay it back. The attached shows the Targeted enhanced recruitment areas you might be interested to see how many areas are covered by it.
medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/general-practice-gp/how-to-apply-for-gp-specialty-training/targeted-enhanced-recruitment-scheme

Easily done

Yes, I did see that, but I didn’t appreciate that you were implying that those staff groups would be employed on similar terms to your proposals for doctors, I read it that more would be needed - crossed wires I think.

This is from my post above (on this page at 11:48:23).

It is, but if we (as a society) knew that the money wasn't being sent abroad it would make sense to invest in training more (and more nurses, radiographers etc).

I'm not saying that a contract would be the answer to all the problems in the NHS, but that it would be a starting point that would allow future planning and to keep some of the money spent on training in the UK.

I did read the whole thread including your posts, but I must admit I can’t identify that you said that specifically about other healthcare professionals, apologies. I wasn’t criticising, but I am trying to understand exactly what you’re proposing in detail. I’m heavily invested in maintaining the NHS, having worked in it for so many years I can see many of the issues, and there certainly aren’t easy answers, medical staffing being one of the most difficult of all, as of course it has been since before the NHS came into being.

Casdon are you reading my posts before you criticise them?

I did say that I would extend free tuition to other medical professionals and that higher recruitment should be done without diluting quality.